B.C. drug users question ‘exceptional’ availability of medicine

Drug users who didn’t respond well to a reformulated methadone treatment introduced in British Columbia four years ago now have access to a medication that may work as well as the original version for some people but advocates worry it’s available only on an “exceptional basis.”

Nearly 18,000 people were switched from methadone to Methadose in 2014. However, drug users say they weren’t consulted before the change to a medication that failed to keep painful withdrawal symptoms at bay for 24 hours.

The new option, called Metadol-D, has recently been offered to Methadose patients, though advocates are questioning why the drug that’s been around for years wasn’t made available sooner.

Dr. Christy Sutherland, who treats substance users in Vancouver’s Downtown Eastside, said Methadose caused substance users to become ”dope sick” in about 14 hours, instead of 24 hours, leading to withdrawal symptoms that had many people seeking intravenous drugs such as heroin on the streets during a crisis fuelled by the deadly opioid fentanyl.

“Methadone and Methadose are supposed to be the same but the entire population said they felt incredibly different with that change,” Sutherland said.

“Patients would always say to me, ‘It doesn’t have legs.’ And what they meant was that it didn’t last the 24 hours,” she said of Methadose. “They would wake up each morning in withdrawal, with cravings, with sweats, sometimes with diarrhea, with pain. So they would be quite desperate for their dose that day. That led to a lot of instability for people.”

Sutherland said she has now switched many of her patients from Methadose to Metadol-D, adding it seems to work well.

She said Metadol-D is the old formulation of methadone for diabetics because it doesn’t contain sugar.

The B.C. Centre on Substance Use has been providing information about Metadol-D to doctors, but they must apply for the medication on an exceptional basis for each patient.

Laura Shaver, who heads the British Columbia Association of People on Methadone, said the former provincial government discontinued the original methadone treatment without consultation, which caused misery for drug users and marginalized people like herself because of withdrawal symptoms.

“For some of us who had been clean off doing any opioids other than the medication, turning back into full-blown needle-using junkies because of a decision that was not ours is absolutely wrong and irresponsible. And many people have died because of it,” she said.

The province has said the switch to Methadose was believed to be a better option because it has a longer shelf life, and was less prone to dispensing errors because pharmacists don’t have to compound it.

A University of British Columbia study of 405 patients published in 2016 in the journal Substance Abuse Treatment, Prevention and Policy, says the switch to Methadose affected a vulnerable population that experienced pronounced negative impacts.

“Over half of participants reported supplementing with other drugs following the transition to Methadose,” the study says, adding that any instability in methadone treatment “leading to a rebound in illicit drug use may result in possible decline in social function and worse health outcomes in B.C.”

Garth Mullins, an advocate with the B.C. Association of People on Methadone, said he has lobbied the government for years to regain access to the original methadone because of its success among thousands of people who didn’t do as well on Methadose.

Mullins, who used heroin for a decade starting in his teens and is on Methadose, said he knows several people who were forced back to street drugs in an effort to cope with withdrawal symptoms.

He said the Metadol-D option came about after a provincial official at a meeting he attended happened to mention it as a possible treatment, even though the medication had existed for years.

“No one around the table had ever heard of it including all these officials and doctors. I said, ‘We’ll try anything.’ “

“I have been working on this since 2014 and I am incredulous that this has not been proposed before, that we’ve lost people because this hasn’t been proposed before. It makes my jaw drop.”

Mullins said Methadose seemed to work for only about half the people who were formerly using methadone and a lack of that stable treatment led to the near-disintegration of Canada’s largest association of methadone users.

“The whole group almost stopped existing in 2014, 2015, because it threw the whole board and most of the membership into a lot of chaos.”

Cheyenne Johnson, a nurse and clinical director at the B.C. Centre on Substance Use, said the information about Metadol-D provided to physicians is also available to patients, whose needs must be respected.

“We’re hoping, through this, that doctors can really have an open dialogue with their patients about the concerns that they are facing in an overdose crisis and the real dangers around fatal overdose for individuals who may return to non-medical opioid use.”